It’s been way too long since the last post in this blog which I don’t even remember when, but never mind because you gaisss, the reader and me are going to break this unbreakable laziness chain to start back today, ahah! It’s never too late for everything, right, right, right? Today marks the end of my ophthalmology posting for undergraduate study which lasted for 3 weeks. Looking back to the first day and day after, it was indeed a one way journey, a memorable one.
– 29 June 2019, Saturday –
Mom called today to enquire about the date of me flying home. I still remember clearly, so is she, that ”I don’t think I’ll like ophthalmology. It’s so eerie, sensitive to touch and fundoscope is such a pain.” Well, my mom as usual was so chill about it, ” That’s what you said for your previous posting and you always ended up liking it.”
– 30 June 2019, Sunday –
Mom was, is and will always be right. It was the first lesson which is about history taking and I was totally pumped up for it. We met our coordinator, and damn! Rumours from previous postings were right. Opthalmologist looked really young and they are really presentable, but very particular with rules either. Also, it’s a posting with lots of Chinese doctors, speaking Mandarin and the cannot-run-away-Chinese-slang.
– 1 July 2019, Monday –
Th day has come, where I’ll overcome my weakness, my black hole, it’s DIRECT FUNDOSCOPY!😦 During the practical, I observed almost 10 dilated eyes, and yes, seen the optic disc, but some cup decided to play hide and seek with me, and when it comes to blood vessels, I am so loss in the jungle of retina. I could not brain with that fact of mentioning pink when what I saw was orange, and that green rim around the optic disk, was not green but grey, which somehow increased my suspicion of me being colour blind. 🌚🌚🌚 Tension adds on when my fellow friends were able to appreciate everything correctly, but all I had was green, green and then loss in the jungle of retina, again! Oh, not to forget the extra imagination, you know, when you’re actually not seeing it, but thinks this is it… nope, I don’t have visual hallucination okay. 😅😅😅 One thing I’ve learnt today, whatever green thing I’m going to see in this coming 3 weeks, let’s just call it grey. 😅😅
– 2 July 2019, Tuesday –
It’s the first day of clinic and the weather choose to be sunny. The clinics was rumoured to be hot and stuffy, but I guess I was kind of lucky today, got attached to prevention of blindness (POB) clinic at the trauma centre which means…. A.C.! Never have I ever thought that I will be this fearful of conjunctivitis, probably because the procedure of removing pseudomembrane from the conjunctiva seems so hurtful to me. We spent most of our times with washing; handwashing, handwashing and not to forget, alcohol-rubbing the slit-lamp. Yes, my friends and I were hell afraid of conjunctivitis. 😂 Oh, not to forget, how mesmerizing it was to observe the eye under slit-lamp, just too beautiful, but it happened to be the eye of a good friend with glare (silau), opps. Sorry, shone too much light! 🙈🙉🙊
– 3 July 2019, Wednesday –
This is the 11th posting I’ve been in, and it is by far the best oncall ever. 😎😎 Probably because we were entertained; had teaching with registrar instead of rounding around the whole hospital with minimal idea of what was going on. Also, I think it’s also because the registrar was really nice, entertained all our not-so-smart-questions and this one most important…. he looked like my Korean oppa okay, 40% la…🙈 The last time I met a real life Korean oppa was like when… during my internal medicine, some more it’s my patient’s neighbour, wtf, and of course I did not pay attention to that discussion because my eyes, brain and heart were too occupied. 🙃🙃🙃
– 4 July 2019, Thursday –
In every posting, I will stan a doctor, my most favourite doctor, yes favouritism is unhealthy, but this is how I keep myself motivated and inspired in each posting hahaha and today, I met her. It’s Prof. Azhany. She is such a lovely doctor which words itself will not be enough to describe how much I like her and yes, her patients will definitely like her, and you must really meet her in person because she is an angel. Not because she spoon fed us during CBL, but I love how she guided me to learn in a better, systematic, easier and logical way. Answering her questions was greatly encouraged, the correct ones were praised, and incorrect ones were not wronged, but corrected.
– 7 July 2019, Sunday –
I was attached to Paediatric Opthal clinic today, with the 40% oppa registrar okay. 😂 Just yesterday, I asked TQH if he had seen any Retinoblastoma case during his posting because I had never seen a leukocoria in live. Blame my mulut masin, today I met one, a new case referred from health clinic. Retinoblastoma. Rare, but life threatening and usually, we will have 1 case every year. This year, *finger crossed*. 😥😥 Throughout the consultation, I learnt what I needed to know, observed the-always-in-practice-breaking-bad-news session, and I was glad that both parents were quite acceptance about it. I read a review [http://www.e-mjm.org/1991/v46n2/Retinoblastoma.pdf], though it’s outdated, but still saddening to read. Here’s me, hoping that they would not default any of their child’s follow up, refuse treatment and opt for traditional medicine instead.
– 10 July 2019, Wednesday –
Jeng! Jeng! Jengggg!! Today is the day, of me, witnessing an operation which I will be needing in future if I am blessed to live long enough to be diagnosed with it, cataract surgery. To be honest, after watching it live, I think watching Youtube is better 🌚😂, but what’s different compared to watching it live is that it feels like you’re watching Jack and the beanstalk. The hands of the surgeon were like giant picking up Jack, the mini tools, and worse for patient is that, you’re awake. I’ll be awake. Maybe I’ll risk my life to have it done under GA or having my lens removed only when I have like a really mature cataract, so that all I see is shadow and blurry hahahahaha. Cataract surgery has quite a big work field, but not for squint. I don’t know, I’m just saying what I see and how I feel, nothing factual. There’s like 3 to 4 pairs of hands, all ranging from glove size 5 to 7 working at like, part of an eye. They stretch the medial rectus muscle with tools just like how you stretch the cheese using a pair of chopsticks for your korean chicken. Well, if you happen to have squint or what we call mata juling and thinks that it ruins your cosmesis, you may consider a squint surgery.
– 13 July 2019, Saturday –
I had been burning midnight oil for the past few days, you know… end of posting exam is tomorrow, until a point where I was really bored with what I’ve been reading. I called home and started clerking my family members for their ocular history. Before I started breathing in this world, both my parents worked at Japan for quite some time before returning to homeland. My dad worked as a labourer where he will be… constructing the road? while my mom works in the office. One day, while he was drilling the road, and yeah… he did not wear any goggles, and poof! Tiny stone had hit his eye as a rebound force. Got back home, complained to my mom for having this gritty sensation (sandy feeling in the eye), blurring of vision and ocular pain. My family was not well-off, even now 😂😂😂 so they tried to self-cure. My mom removed the foreign bodies manually while my dad persistently went to work for a few days, with his non-improving ocular pain and blurring of vision. 3 days later which happened to be weekend, they went to seek for treatment in view of symptoms not improving at a general practitioner who was highly recommended by Mama-san. GP then referred him to the hospital. They had a tough time in the hospital because the doctor only spoke Japanese. Luckily, the opthalmology department had a Taiwanese doctor who happened to be oncall that day, so lucky that they found someone who understands mandarin. The treatment cost was costly, which I don’t know how they manage to halved the cost upon discussion, foreigner some more. Blood was taken, imaging was done and the list continues…. and there’s another cost to consider, the lens. The whole treatment would cost almost all their earnings in Japan, but I am grateful that they chose to cherish life and eyesight. Post-operation, only then my parents knew that dad’s newly implanted intraocular lens was self-made by the hospital professor for him as a gift.😭 The treatment cost was even lowered when the doctors decided to play hide-and-seek with the bills 😭, and the company boss paid for the remaining cost. My dad is still proud as ever with his lens 🌚, and will never get bored of mentioning to us that it’s made in Japan. I felt really touched and grateful for the help offered despite my parents being foreigners in another country, and I got to see and feel the beauty of medicine. 😌😌😌 *I want to kraiii 😭😭😭😭😭* To the fellow doctors who are kind enough to help my parents when I wasn’t even fertilized yet, thank you, thank you and thank you. ☺☺☺
– 16 July 2019, Tuesday –
Today @ HRPZ hospital, I think…., yessss! I am going to get a pair of goggles for my dad who likes to crack the firecrackers during Chinese New Year, and force my children, adopted or from my own ovum, I don’t care. All must wear safety goggles when play firecrackers. Even better, don’t play at all, we watch other people burn big big fireworks, watch them burn their money also hahahahahaha. So, it’s an alleged firecracker trauma case where this boy who was not playing firecrackers happened to be around his cousins who were cracking the firecrackers, and it was so unfortunate that one of the firecrackers which was lighted burst and the pieces of it flew to the boy’s left eye, causing him to sustain a left eye traumatic cataract and eye infection, endophthalmitis. Missed school for 1 month, still in pain and could only perceive light. In conclusion, don’t play, don’t be around kids with fireworks or best, just wear safety goggles everywhere. 😂😂😂😂😂
– 17 July 2019, Wednesday –
I think this is worth documenting. Today, I manage to perform direct fundoscopy on an undilated pupil. Bilateral eyes had a cup-disk-ratio 0.9, and this uncle had underlying bilateral glaucoma with left eye being his precious eye. I hope his vision stays the same, let it be visual field or visual acuity, because taking away the sight from a person who has been seeing for 60 years, it’s saddening to even think about it.😢😢 No matter how long one had live; 50, 100 or 1000 years, one will never get enough of vision. Well, never enough for me.
– 20 July 2019, Saturday –
Today, my teammates and I will be participating community eye screening together with fellow doctors at a mosque located in Bukit Bunga, Tanah Merah, Kelantan. The problem is…
I am not an early sleeper, and definitely not a morning person either. The whole night had me flipping left and right, even worse when I slept till afternoon this morning. And finally, ahhhh… manage to doze off ~ 4 hours, and dragged myself to Padang Kawad by 7.30am. Much to my surprise, the usual late comers were there already, and for the first time in Year 4 Group 4, everyone was on time although most of us are not morning people. Throughout the bus ride there which took us about 1hour 30minutes, it was quiet; probably because everyone is trying to grasp their last second of sleep before the real work. Upon reaching, we helped setting up the place and then divided tasks between us. Many chose to do visual acuity and there’s me being assigned to do fundoscopy. Responsibility got real when we, the first-liner who screened the eyes were given the rights to decide if the people needed to be seen by doctors. What if we misinterpreted an abnormal finding as normal? What if we missed any present haemorrhages, exudates and cotton wool spots? What if we mis… what if…. just so many what if, and it’s undilated pupil. *pandainya bagi alasan* 🤭🤭🤭
First pupil came and sat on my chair. Rapport was build, and with the skills I obtained within 3 weeks, I felt moved when the optic disc decided to say hi. Being able to view it through undilated pupil no longer became a luck, but a skill which will help me to carry myself as a physician in future. Then, the next problem came, the vessels. Sometimes while observing along the retina vessel, the eye muscles suddenly decided to start an eye-quake with a magnitude of 6.0, and then poof! I’m lost in the jungle of retina. I totally agree with the fact that I’m slow, and I almost gave up almost every time with these eye-quake pupils. However, I don’t know why, tiba-tiba je (suddenly), my mind goes thinking, ”You wouldn’t want a doctor to look into your dad’s eyes and tell him he’s okay when the doctor had not seen all parts, don’t you?” It became my quote of the day to keep me moving, observing whichever possible parts of retina. Also, my friend manage to detect a resident with 4 days sudden onset of right cranial nerve III palsy with sparring pupils (this uncle had right eye exotropia, limited eye movement with ptosis) and doctor referred him immediately to the nearest hospital with imaging facility to rule out aneurysm. The uncle who came with ease for a screening slowly turns sorrowful, and continuously questioned doctor if there’s an alternative or cure for it. I really do hope everything went fine with him.
The day ends well. Most of the residents with refractive error and presbyopia (rabun tua) got their new glasses for free. Elderly with mature cataract were referred to HUSM for follow up and cataract surgery. Also, we got to taste local fruits; durian, nangka, papaya, coconut, mango, durian, durian, well most important is durian la…. at the end of the day. Also as usual, USM style in every event is to take lots of pictures; group pictures with banner, without banner, front view, lateral view, 30 degree, 90 degree. It’s 4pm, with sign of time to go;us with oily hair, oily face, stinky and sweaty body. The ride back to USM was peaceful too, probably because everyone barai (fallen) already 😂. Though tiring, this journey is definitely worth it. Part of the community is going to have their blindness treated, those who need spectacles obtain them for free and the healthy young and elderly continuously feel proud with their 6/6 vision. It has always been pleasant to me to be able to interact and serve the community, maybe because I didn’t encounter what my friend faced; the mak ciks who complained of long queuing time. Lucky me, phew! ✌🏽
All in all, this is going to be my last ophthalmology posting 😂😂😂😂😂, but definitely not my last time performing an eye examination, holding a fundoscope and getting further history from a person with eye complaint. It’s a quite eventful posting I would say, probably due to lots of discipline issues, not me but it made us better homo sapiens. 3 weeks of studying the eye, from not knowing proper way of using fundoscope to being able to view the retina and optic disc of an undilated pupil, from seeing all red eye patients as the same to being able to narrow down to a diagnosis, from seeing all exopthalmos as thyroid problem to other differentials, from wanting to try contact lens to an anti-contact lens person, from a person who took it easy on eyesight to a person who embrace the importance of eyesight and from a person who hates ophthalmology even before entering the posting itself to a person who likes it, I really learnt a lot, and I am glad and love the fact that I’m in medicine even more. Thank you, opthal. May you be kind to me even in future. ☺☺☺
– End –
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